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Wang RJ, Bhakta NR. The Puzzle of Marijuana Use and Forced Vital Capacity. Ann Am Thorac Soc 2024; 21:683-691. [PMID: 38271695 PMCID: PMC11109910 DOI: 10.1513/annalsats.202312-1010cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
In study after study, marijuana use has been found to be associated with increased forced vital capacity (FVC). This is puzzling, because marijuana is commonly consumed by inhalation of its smoke, and smoke exposure of any kind is not generally considered a cause of increased FVC. Although this observation was first made decades ago, a satisfactory explanation remains elusive. In this review we survey the evidence supporting the relationship between marijuana use and increased FVC, discuss potential threats to validity when inferring causation, and, presupposing a possible causal relationship, pose two key questions. First, what are possible physiologic or pathophysiologic mechanisms by which marijuana use might increase FVC? Second, why might this effect be consistently observed with marijuana use but not with tobacco use? Explanations for the first question include lung and chest growth and remodeling from strenuous marijuana smoke inhalation and reductions in lung elastic recoil from marijuana smoke exposure. Explanations for the second include differences between marijuana and tobacco in smoke composition and patterns of consumption, such as smoking topography. Finally, the possibility that smoke, whether from marijuana or tobacco, might have nonmonotonic effects on FVC depending on the degree of exposure is explored. In synthesizing a curated breadth of epidemiologic and physiologic science, we leverage a perplexing observation to generate potential insights and avenues for further research into the biological effects of smoke, from marijuana or otherwise, on the respiratory system.
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Affiliation(s)
- Richard J Wang
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Nirav R Bhakta
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
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Ahmed S, Chowdhury MAH, Kader SB, Shahriar MH, Begum BA, Eunus M, Sarwar G, Islam T, Alam DS, Parvez F, Raqib R, Ahsan H, Yunus M. Personal exposure to household air pollution and lung function in rural Bangladesh: A population-based cross-sectional study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:385-397. [PMID: 36436222 PMCID: PMC10220216 DOI: 10.1080/09603123.2022.2150150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/16/2022] [Indexed: 05/29/2023]
Abstract
We assessed whether personal exposure to household air pollution [PM2.5 and black carbon (BC)] is associated with lung functions (FEV1, FVC, and their ratio) in non-smoking adults in rural Bangladesh. We measured personal exposure to PM2.5 using gravimetric analysis of PM2.5 mass and BC by reflectance measurement between April 2016 and June 2019. The average 24-hour PM2.5 and BC concentration was 141.0μgm-3 and 13.8μgm-3 for females, and 91.7 μgm-3 and 10.1 μgm-3 for males, respectively. A 1 μgm-3 increase in PM2.5 resulted in a 0.02 ml reduction in FEV1, 0.43 ml reduction in FVC, and 0.004% reduction in FEV1/FVC. We also found a similar inverse relationship between BC and lung functions (9.6 ml decrease in FEV1 and 18.5 ml decrease in FVC per 1μgm-3 increase in BC). A higher proportion of non-smoking biomass fuel users (50.1% of the females and 46.7% of the males) had restrictive patterns of lung function abnormalities, which need further exploration.
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Affiliation(s)
- Shyfuddin Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Muhammad Ashique Haider Chowdhury
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Department of Public Health Sciences, Biological Science Division, The University of Chicago, Chicago, IL, USA
| | | | - Mohammad Hasan Shahriar
- Department of Public Health Sciences, Biological Science Division, The University of Chicago, Chicago, IL, USA
- UChicago Research, Dhaka, Bangladesh
| | | | | | | | | | - Dewan S Alam
- Independent Global Health Epidemiologist, School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Faruque Parvez
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rubhana Raqib
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Habibul Ahsan
- Department of Public Health Sciences, Biological Science Division, The University of Chicago, Chicago, IL, USA
- UChicago Research, Dhaka, Bangladesh
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Institute for Population and Precision Health, The University of Chicago, Chicago, IL, USA
| | - Md Yunus
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
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Sarno G, Stanisci I, Maio S, Williams S, Ming KE, Diaz SG, Ponte EV, Lan LTT, Soronbaev T, Behera D, Tagliaferro S, Baldacci S, Viegi G. Issue 2 - "Update on adverse respiratory effects of indoor air pollution". Part 2): Indoor air pollution and respiratory diseases: Perspectives from Italy and some other GARD countries. Pulmonology 2023:S2531-0437(23)00083-1. [PMID: 37211526 DOI: 10.1016/j.pulmoe.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVE to synthesize the Italian epidemiological contribution to knowledge on indoor pollution respiratory impact, and to analyze the perspective of some GARD countries on the health effects of indoor air pollution. RESULTS Italian epidemiological analytical studies confirmed a strong relationship between indoor air pollution and health in general population. Environmental tobacco smoke, biomass (wood/coal) fuel for cooking/heating and indoor allergens (house dust mites, cat and dog dander, mold/damp) are the most relevant indoor pollution sources and are related to respiratory and allergic symptoms/diseases in Italy and in other GARD countries such as Mexico, Brazil, Vietnam, India, Nepal and Kyrgyzstan. Community-based global health collaborations are working to improve prevention, diagnosis and care of respiratory diseases around the world, specially in low- and middle-income countries, through research and education. CONCLUSIONS in the last thirty years, the scientific evidence produced on respiratory health effects of indoor air pollution has been extensive, but the necessity to empower the synergies between scientific community and local administrations remains a challenge to address in order to implement effective interventions. Based on abundant evidence of indoor pollution health effect, WHO, scientific societies, patient organizations and other members of the health community should work together to pursue the GARD vision of "a world where all people breathe freely" and encourage policy makers to increase their engagement in advocacy for clean air.
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Affiliation(s)
- G Sarno
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - I Stanisci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Maio
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Williams
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - K E Ming
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - S G Diaz
- Universidad Autónoma de Nuevo León, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Av. Dr. José Eleuterio González 235, Mitras Centro, 64460 Monterrey, N.L., Mexico
| | - E V Ponte
- Faculdade de Medicina de Jundiaí - Department of Internal Medicine, R. Francisco Teles, 250, Vila Arens II, Jundiaí SP, 13202-550, Brazil
| | - L T T Lan
- University Medical Center, 217 Hong Bang, dist.5, Ho Chi Minh City 17000, Vietnam
| | - T Soronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Togolok Moldo str., Bishkek 720040, Kyrgyzstan
| | - D Behera
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases (NITRD), Sri Aurobindo Marg Near Qutub Minar, Mehrauli, New Delhi 110030, India
| | - S Tagliaferro
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Baldacci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - G Viegi
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy.
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Chai CS, Ng DLC, Bt Mos S, Ibrahim MAB, Tan SB, Pang YK, Liam CK. COPD exacerbations and patient-reported outcomes according to post-bronchodilator FEV 1 - a post-hoc analysis of pooled data. BMC Pulm Med 2023; 23:150. [PMID: 37118725 PMCID: PMC10148499 DOI: 10.1186/s12890-023-02436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/15/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Management strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV1), exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV1, exacerbations, and PROs of patients with stable COPD. METHODS This was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV1 (PB-FEV1), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used. RESULTS Three hundred seventy-four patients were included in the analysis. The PB-FEV1 predicted was < 30% in 85 (22.7%), 30-49% in 142 (38.0%), 50-79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV1 < 30% predicted had significantly more COPD exacerbations than those with PB-FEV1 30-49% predicted (p < 0.001), 50-79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV1 (p = 0.121-0.271). The PB-FEV1 predicted had significant weak negative correlations with exacerbations (r = - 0.182, p < 0.001), mMRC (r = - 0.121, p = 0.020), and SGRQ-c scores (r = - 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407-0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001). CONCLUSIONS In COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was weak.
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Affiliation(s)
- Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Sumastika Bt Mos
- Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Muhammad Amin B Ibrahim
- Department of Medicine, Faculty of Medicine, University Technology MARA, Sungai Buloh, Selangor, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong-Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Wang Y, Duong M, Brauer M, Rangarajan S, Dans A, Lanas F, Lopez-Jaramillo P, Puoane T, Yeates K, Chifamba J, Yusuf R, Liu Z, Li Y, Tse LA, Mohan D, Gupta R, Nair S, Lakshmi P, Iqbal R, Anto T, Yusuf S, Hystad P. Household Air Pollution and Adult Lung Function Change, Respiratory Disease, and Mortality across Eleven Low- and Middle-Income Countries from the PURE Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:47015. [PMID: 37126654 PMCID: PMC10132780 DOI: 10.1289/ehp11179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Globally, household air pollution (HAP) is a major environmental hazard that affects respiratory health. However, few studies have examined associations between HAP and lung function decline and respiratory disease and mortality. METHODS We used data from the Prospective Urban and Rural Epidemiology study and examined adults residing in 240 rural communities in 11 low- and middle-income countries where HAP from cooking with solid fuels is common. Spirometry was conducted for 28,574 individuals at baseline and 12,489 individuals during follow-up (mean of 8 y between spirometry measures). In cross-sectional analyses, we compared lung function measurements [forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio] in those who used solid fuels for cooking in comparison with clean fuels. Using repeated measurements of lung function, we examined the percent change in lung function measures per year, comparing individuals by baseline fuel type and individuals who used solid fuels at baseline but switched to clean fuels during follow-up. We also examined associations with prospective health events (any respiratory diseases, respiratory disease hospitalizations, and all-cause mortality). RESULTS In adjusted cross-sectional models, use of solid fuel in comparison with clean fuels was associated with lower FEV1 of -17.5mL (95% CI: -32.7, -2.3) and FVC of -14.4mL (95% CI: -32.0, 3.2), but not FEV1/FVC. In longitudinal analyses, individuals who switched from solid fuels to clean cooking fuels during follow-up (n=3,901, 46% of those using solid fuel at baseline), showed no differences in the annual rate of change in FEV1 or FVC, but had small improvements in FEV1/FVC change (0.2% per year, 95% CI: 0.03, 0.3). Individuals who switched from solid to clean fuels had a decreased hazard ratio for respiratory events of 0.76 (95% CI: 0.57, 1.00) in comparison with persistent solid fuel users, which was not attenuated by lung function measures. CONCLUSION We observed modest associations between HAP exposure and lung function, lung function change, and respiratory disease and mortality. https://doi.org/10.1289/EHP11179.
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Affiliation(s)
- Ying Wang
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Antonio Dans
- University of the Philippines, Ermita, Manila, Philippines
| | - Fernando Lanas
- Universidad de La Frontera, Francisco Salazar, Temuco, Chile
| | | | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Zhiguang Liu
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Sanjeev Nair
- Health Action By People, Government Medical College, Trivandrum, India
| | - Pvm Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Taniya Anto
- Department of Physiology, St. John's Medical College, Bangalore, India
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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Ismail AU, Ibrahim SA, Gambo MD, Muhammad RF, Badamasi MM, Sulaiman I. Impact of differential occupational LPG exposure on cardiopulmonary indices, liver function, and oxidative stress in Northwestern city of Nigeria. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 862:160881. [PMID: 36521592 DOI: 10.1016/j.scitotenv.2022.160881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
Exposure to hydrocarbon products has been associated with numerous health risks and toxicities. Outdoor or indoor occupational exposure to highly volatile and lipid-soluble hydrocarbons has been linked to impairment of respiratory, cardiovascular, and liver functions. This study is aimed at determining the potential impact of occupational exposure to liquefied petroleum gas (LPG) in varying work environments. Respiratory symptoms, oxidative stress, cardio-pulmonary, and liver function parameters were assessed among LPG workers in the Kano metropolis, Nigeria. Study subjects were recruited from LPG filling stations and street LPG retail shops. Results of the study showed that the forced vital capacity (FVC) of LPG station workers was significantly lower (2.81 L/min; H = 22.473, p < 0.001) relative to the values recorded among LPG retail shop workers and the controls (3.54 L/min and 4.24 L/min respectively). A similar reduction was seen in the forced expiratory volume in the first second (FEV1) and the forced expiratory flow in 25-75 % of forced vital capacity (FEF25-75) obtained from the filling station workers (H = 32.722, p < 0.001 & H = 15.655, p <0.001 respectively). Furthermore, exposure to non-combusted LPG increased systolic blood pressure, mean arterial pressure, and serum liver enzymes. Findings from this study revealed that despite the high amount of coarse particulate matter in LPG retail shops, the filling station workers are more susceptible to the impairment of lung function possibly due to the high quantity of total volatile organic compounds (TVOCs) in the filling station environment.
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Affiliation(s)
- Abubakar Usman Ismail
- Department of Human Physiology, Faculty of Basic Health Sciences, Al - Istiqama University, Nigeria; Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Nigeria
| | - Salisu Ahmed Ibrahim
- Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Nigeria
| | - Mahdi Dissi Gambo
- Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Nigeria
| | - Ramlah Farouq Muhammad
- Department of Human Physiology, Faculty of Basic Medical Sciences, Yusuf Maitama Sule University Kano, Nigeria
| | | | - Ibrahim Sulaiman
- Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Nigeria; Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados.
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Mechanisms of Lung Damage and Development of COPD Due to Household Biomass-Smoke Exposure: Inflammation, Oxidative Stress, MicroRNAs, and Gene Polymorphisms. Cells 2022; 12:cells12010067. [PMID: 36611860 PMCID: PMC9818405 DOI: 10.3390/cells12010067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
Chronic exposure to indoor biomass smoke from the combustion of solid organic fuels is a major cause of disease burden worldwide. Almost 3 billion people use solid fuels such as wood, charcoal, and crop residues for indoor cooking and heating, accounting for approximately 50% of all households and 90% of rural households globally. Biomass smoke contains many hazardous pollutants, resulting in household air pollution (HAP) exposure that often exceeds international standards. Long-term biomass-smoke exposure is associated with Chronic Obstructive Pulmonary Disease (COPD) in adults, a leading cause of morbidity and mortality worldwide, chronic bronchitis, and other lung conditions. Biomass smoke-associated COPD differs from the best-known cigarette smoke-induced COPD in several aspects, such as a slower decline in lung function, greater airway involvement, and less emphysema, which suggests a different phenotype and pathophysiology. Despite the high burden of biomass-associated COPD, the molecular, genetic, and epigenetic mechanisms underlying its pathogenesis are poorly understood. This review describes the pathogenic mechanisms potentially involved in lung damage, the development of COPD associated with wood-derived smoke exposure, and the influence of genetic and epigenetic factors on the development of this disease.
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Hsan S, Lakhdar N, Harrabi I, Zaouali M, Burney P, Denguezli M. Reduced forced vital capacity is independently associated with, aging, height and a poor socioeconomic status: a report from the Tunisian population-based BOLD study. BMC Pulm Med 2022; 22:267. [PMID: 35818049 PMCID: PMC9275164 DOI: 10.1186/s12890-022-02062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Reduced forced vital capacity (FVC) is a risk factor of all-cause mortality; however, the prevalence and determinants of reduced FVC are not available for the Tunisian population. This study investigated the association of reduced FVC with risk factors and health variables in an urban population of subjects aged ≥ 40 years and living in the city of Sousse in Tunisia. Methods A cross-sectional survey was performed using data from the Tunisian Burden of Obstructive Lung Disease (BOLD) study. We defined reduced FVC as a post-bronchodilator FVC below the lower limit of normal using National Health and Nutrition Examination Survey (NHANES) values and Global Lung Function Initiative 2012 equations (GLI 2012) and determined the relation between this finding and the potential risk factors (demographic and socioeconomic factors and the presence of chronic diseases), using multivariable regression analysis. Results The prevalence of reduced FVC was 26.6% (176/661) when using NHANES values for white Americans and 14.2% (94/661) using the GLI 2012 equations. Compared to people with normal FVC, those with a reduced FVC were significantly older, taller, had a lower body mass index (BMI), more respiratory symptoms and a higher prevalence of heart disease and hypertension. Multivariable analysis showed that reduced FVC was essentially driven by exposure to biomass smoke for heating, a number of schooling years lower than or equal to 6 years, a childhood history of hunger for a lack of money, aging and height. Conclusions The prevalence of reduced FVC is associated with a poor socioeconomic status aging and height.
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Affiliation(s)
- Safa Hsan
- Laboratoire de recherche: Physiologie de l'exercice et physiopathologie: de l'intégré au moleculaire, LR19ES09, Faculté de Médecine de Sousse, Université de Sousse, 4000, Sousse, Tunisia
| | - Nadia Lakhdar
- Laboratoire de recherche: Physiologie de l'exercice et physiopathologie: de l'intégré au moleculaire, LR19ES09, Faculté de Médecine de Sousse, Université de Sousse, 4000, Sousse, Tunisia
| | - Imed Harrabi
- Service d'épidémiologie, Faculté de Médecine de Sousse, Hôpital Farhat Hached, Université de Sousse, 4000, Sousse, Tunisia
| | - Monia Zaouali
- Laboratoire de recherche: Physiologie de l'exercice et physiopathologie: de l'intégré au moleculaire, LR19ES09, Faculté de Médecine de Sousse, Université de Sousse, 4000, Sousse, Tunisia
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Meriam Denguezli
- Laboratoire de recherche: Physiologie de l'exercice et physiopathologie: de l'intégré au moleculaire, LR19ES09, Faculté de Médecine de Sousse, Université de Sousse, 4000, Sousse, Tunisia. .,Faculté de Médecine Dentaire de Monastir, Université de Monastir, Avenue Avicenne, Monastir, Tunisia.
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Terfa ZG, Nantanda R, Lesosky M, Devereux G, Obasi A, Mortimer K, Khan J, Rylance J, Niessen LW. Household food insecurity, maternal nutrition, environmental risks and infants' health outcomes: protocol of the IMPALA birth cohort study in Uganda. BMJ Open 2022; 12:e050729. [PMID: 35304392 PMCID: PMC8935180 DOI: 10.1136/bmjopen-2021-050729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In low- and middle-income countries (LMICs), food insecurity and undernutrition disproportionately affect women of reproductive age, infants and young children. The disease burden from undernutrition in these vulnerable sections of societies remains a major concern in LMICs. Biomass fuel use for cooking is also common in LMICs. Empirical evidence from high-income countries indicates that early life nutritional and environmental exposures and their effect on infant lung function are important; however, data from sub-Saharan Africa are scarce. AIM To estimate the association between infant lung function and household food insecurity, energy poverty and maternal dietary diversity. METHODS AND ANALYSIS Pregnant women will be recruited in an existing Health and Demographic Surveillance Site in South-West Uganda. Household food insecurity, sources and uses of energy, economic measures and maternal dietary diversity will be collected during pregnancy and after birth. Primary health outcomes will be infant lung function determined by tidal breath flow and volume analysis at 6-10 weeks of age. Infant weight and length will also be collected.A household Food Consumption Score and Minimum Dietary Diversity for Women (MDD-W) indicator will be constructed. The involved cost of dietary diversity will be estimated based on MDD-W. The association between household level and mothers' food access indicators and infant lung function will be evaluated using regression models. The Multidimensional Energy Poverty Index (MEPI) will be estimated and used as an indicator of households' environmental exposures. The association between household MEPI and infant lung function will be assessed using econometric models. ETHICS AND DISSEMINATION Ethical approvals have been obtained from Liverpool School of Tropical Medicine (18-059), the Uganda Virus Research Institute Ethics Committee (097/2018) and Uganda National Council for Science and Technology (SS 4846). Study results will be shared with participants, policy-makers, other stakeholders and published in peer-reviewed journals.
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Affiliation(s)
- Zelalem G Terfa
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Center for Environment and Development, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca Nantanda
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Public Health & Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Graham Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jahangir Khan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Västra Götaland, Sweden
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
| | - Louis Wihelmus Niessen
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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Liu GY, Kalhan R. Impaired Respiratory Health and Life Course Transitions From Health to Chronic Lung Disease. Chest 2021; 160:879-889. [PMID: 33865834 DOI: 10.1016/j.chest.2021.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/21/2022] Open
Abstract
Primary prevention and interception of chronic lung disease are essential in the effort to reduce the morbidity and mortality caused by respiratory conditions. In this review, we apply a life course approach that examines exposures across the life span to identify risk factors that are associated with not only chronic lung disease but also an intermediate phenotype between ideal lung health and lung disease, termed "impaired respiratory health." Notably, risk factors such as exposure to tobacco smoke and air pollution, as well as obesity and physical fitness, affect respiratory health across the life course by being associated with both abnormal lung growth and lung function decline. We then discuss the importance of disease interception and identifying those at highest risk of developing chronic lung disease. This work begins with understanding and detecting impaired respiratory health, and we review several promising molecular biomarkers, predictive symptoms, and early imaging findings that may lead to a better understanding of this intermediate phenotype.
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Affiliation(s)
- Gabrielle Y Liu
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Ravi Kalhan
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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11
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Ekezie W, Jenkins AR, Hall IP, Evans C, Koju R, Kurmi OP, Bolton CE. The burden of chronic respiratory diseases in adults in Nepal: A systematic review. Chron Respir Dis 2021; 18:1479973121994572. [PMID: 34227410 PMCID: PMC8264743 DOI: 10.1177/1479973121994572] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/07/2021] [Accepted: 01/23/2021] [Indexed: 12/11/2022] Open
Abstract
While chronic lung disease causes substantial global morbidity and mortality, global estimates have primarily been based on broad assumptions. Specific country data from low-income countries such as Nepal are limited. This review assessed primary evidence on chronic respiratory disease burden among adults in Nepal. A systematic search was performed in June 2019 (updated May 2020) for studies through nine databases. High levels of heterogeneity deemed a narrative synthesis appropriate. Among 27 eligible studies identified, most were low-moderate quality with cross-sectional and retrospective study design. Chronic lung diseases identified were chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis and restrictive lung diseases. Studies were categorised as: (i) community-based, (ii) hospital-based and (iii) comorbidity-related and disease burden. Reported disease prevalence varied widely (COPD, 1.67-14.3%; asthma, 4.2-8.9%). The prevalence of airflow obstruction was higher among rural dwellers (15.8%) and those exposed to household air pollution from domestic biomass burning as opposed to liquid petroleum gas users (Odds Ratio: 2.06). Several comorbidities, including hypertension and diabetes mellitus added to the disease burden. The review shows limited literature on lung disease burden in Nepal. Publications varied in terms of overall quality. Good quality research studies with prospective cohorts related to respiratory conditions are required.
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Affiliation(s)
- Winifred Ekezie
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Epidemiology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alex Robert Jenkins
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ian Philip Hall
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- Nottingham Centre for Evidence Based Healthcare, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rajendra Koju
- Department of Medicine, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Om Prakash Kurmi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Charlotte Emma Bolton
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
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12
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Kelly FJ, Fussell JC. Global nature of airborne particle toxicity and health effects: a focus on megacities, wildfires, dust storms and residential biomass burning. Toxicol Res (Camb) 2020; 9:331-345. [PMID: 32905302 PMCID: PMC7467248 DOI: 10.1093/toxres/tfaa044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 01/01/2023] Open
Abstract
Since air pollutants are difficult and expensive to control, a strong scientific underpinning to policies is needed to guide mitigation aimed at reducing the current burden on public health. Much of the evidence concerning hazard identification and risk quantification related to air pollution comes from epidemiological studies. This must be reinforced with mechanistic confirmation to infer causality. In this review we focus on data generated from four contrasting sources of particulate air pollution that result in high population exposures and thus where there remains an unmet need to protect health: urban air pollution in developing megacities, household biomass combustion, wildfires and desert dust storms. Taking each in turn, appropriate measures to protect populations will involve advocating smart cities and addressing economic and behavioural barriers to sustained adoption of clean stoves and fuels. Like all natural hazards, wildfires and dust storms are a feature of the landscape that cannot be removed. However, many efforts from emission containment (land/fire management practices), exposure avoidance and identifying susceptible populations can be taken to prepare for air pollution episodes and ensure people are out of harm's way when conditions are life-threatening. Communities residing in areas affected by unhealthy concentrations of any airborne particles will benefit from optimum communication via public awareness campaigns, designed to empower people to modify behaviour in a way that improves their health as well as the quality of the air they breathe.
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Affiliation(s)
- Frank J Kelly
- NIHR Health Protection Research Unit in Environmental Exposures and Health, School of Public Health, Sir Michael Uren Building, Imperial College London, White City Campus, 80-92 Wood Lane, London W12 0BZ, UK
| | - Julia C Fussell
- NIHR Health Protection Research Unit in Environmental Exposures and Health, School of Public Health, Sir Michael Uren Building, Imperial College London, White City Campus, 80-92 Wood Lane, London W12 0BZ, UK
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13
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Nantanda R, Buteme S, van Kampen S, Cartwright L, Pooler J, Barton A, Callaghan L, Mirembe J, Ndeezi G, Tumwine JK, Kirenga B, Jones R. Feasibility and acceptability of a midwife-led health education strategy to reduce exposure to biomass smoke among pregnant women in Uganda, A FRESH AIR project. Glob Public Health 2019; 14:1770-1783. [PMID: 31345124 DOI: 10.1080/17441692.2019.1642931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives.
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Affiliation(s)
- Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences , Kampala , Uganda.,Department of Paediatrics and Child Health, Makerere University College of Health Sciences , Kampala , Uganda
| | - Shamim Buteme
- Makerere University Lung Institute, Makerere University College of Health Sciences , Kampala , Uganda
| | - Sanne van Kampen
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Lucy Cartwright
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Jill Pooler
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Andy Barton
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Lynne Callaghan
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Jean Mirembe
- Directorate of Health Services , Jinja District , Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences , Kampala , Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences , Kampala , Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences , Kampala , Uganda.,Department of Internal Medicine, Makerere University College of Health Sciences , Kampala , Uganda
| | - Rupert Jones
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
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14
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Pathak U, Kumar R, Suri TM, Suri JC, Gupta NC, Pathak S. Impact of biomass fuel exposure from traditional stoves on lung functions in adult women of a rural Indian village. Lung India 2019; 36:376-383. [PMID: 31464208 PMCID: PMC6710971 DOI: 10.4103/lungindia.lungindia_477_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction Exposure to biomass fuel (BMF) from traditional cookstoves inflicts an enormous burden of morbidities in women across the developing world. This study aims to assess the lung function and its association with the indoor air pollutants generated using BMF. Materials and Methods This cross-sectional study including 310 women was conducted in a rural village of India. Households were divided into two groups based on the cooking fuel, the BMF group and the liquefied petroleum gas (LPG) group. Information on respiratory symptoms and socioeconomic status was obtained using a standard questionnaire. Indoor air concentration for PM10and PM2.5was measured during cooking hours. Pulmonary function tests (PFTs) were conducted for the women inhabitants. Results On comparing the two groups, the concentration of PM10(890.26 ± 59.59 vs. 148.66 ± 31.97) μg/m3 and PM2.5(728.90 ± 50.20 vs. 99.76 ± 41.80) μg/m3 (P < 0.01) were higher in the group using BMF. The respiratory symptoms such as wheezing, dyspnea, chronic cough, and nocturnal cough, were significantly more common in the group using BMF. A significant difference was seen in the lung function indices between the two groups. A significant negative correlation of respiratory indices with duration of exposure and the particulate matter (PM) values suggested a greater decline on lung function among women exposed to increased concentrations of PM. On comparing participants with normal and abnormal PFT, it was seen that the use of BMF (odds ratio [OR] 8.01; 95% confidence interval [CI] 4.80, 13.36, P < 0.001) and the duration of exposure to BMF (OR 1.16; 95% CI 1.13, 1.20., P < 0.001) increased the odds of having an abnormal PFT. Conclusions This study shows a high prevalence of respiratory symptoms and an abnormal pulmonary function in women exposed to BMF.
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Affiliation(s)
- Utkarsha Pathak
- University School of Environment Management, Guru Gobind Singh Indraprastha University, Dwarka, New Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Tejas M Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, AlIMS, New Delhi, India
| | - J C Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - N C Gupta
- University School of Environment Management, Guru Gobind Singh Indraprastha University, Dwarka, New Delhi, India
| | - Sharmishtha Pathak
- Department of Neuroanaesthesiology and Neuro Critical Care, AIIMS, New Delhi, India
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15
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Fernandes AGO, de Souza-Machado C, Pinheiro GP, de Oliva ST, Mota RCL, de Lima VB, Cruz CS, Chatkin JM, Cruz ÁA. Dual exposure to smoking and household air pollution is associated with an increased risk of severe asthma in adults in Brazil. Clin Transl Allergy 2018; 8:48. [PMID: 30555680 PMCID: PMC6287342 DOI: 10.1186/s13601-018-0235-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between smoking, household pollution, dual exposure and severity of asthma in adults has not been sufficiently studied. We examined and compared the effects of cigarette smoking, domestic wood burning pollution and dual exposure (tobacco and wood burning) upon asthma severity in adults. Methods This was a cross-sectional study performed with 452 individuals with mild to moderate asthma and 544 patients with severe asthma (previously untreated). Smoking and exposure to wood smoke were identified and quantified through questionnaires to evaluate current and/or previous exposure; objective determination of cigarette exposure was obtained through the measurement of urinary cotinine. Asthma control was evaluated through Asthma Control Questionnaire; and severity was classified according to the Global Initiative for Asthma criteria. Subjects were grouped according to exposure type into 4 groups: smokers, household pollution, dual-exposure and no-exposure. Chi square, Mann-Whitney, and Kruskal-Wallis tests were used for comparisons between groups. Results Out of 996 included individuals, 78 (7.8%) were exposed to cigarette smoking alone, 358 (35.9%) to household pollution alone, 155 (15.6%) to the two exposures combined and 405 (40.7%) were not exposed. Compared to unexposed individuals, exposure to household pollution resulted in poorer asthma control, higher proportion of severe asthma, and worse indicators of lung function. The double-exposed individuals were worse off in all the evaluated parameters, and they were significantly worse than subjects with single exposure to household air pollution in relation to asthma severity and lung function. These subjects were predominantly females, older, with longer residence time in rural areas, lower income and lower schooling levels. Multivariate analysis showed that exposure to household pollution and double exposure were predictive factors associated with lack of control and increased severity of asthma. Conclusions Exposure to household pollution is associated with poorer control, greater severity, and poorer pulmonary function; double-exposed individuals have a greater risk of severe asthma and decreased lung function than those exposed only to household pollution.
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Affiliation(s)
- Andréia Guedes Oliva Fernandes
- 1Programa para o Controle da Asma na Bahia (ProAR) e Programa de Pós-graduação em Medicina e Saúde, Centro de Saúde Carlos Gomes, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Rua Carlos Gomes 270, 7° andar, Salvador, Bahia 40060-330 Brazil
| | - Carolina de Souza-Machado
- 2Programa para o Controle da Asma na Bahia (ProAR) e Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Escola de Enfermagem da Universidade Federal da Bahia, UFBA, Rua Dr Augusto Vianna. 2 andar. Campus Canela, Salvador, Bahia 40110-060 Brazil
| | - Gabriela Pimentel Pinheiro
- 1Programa para o Controle da Asma na Bahia (ProAR) e Programa de Pós-graduação em Medicina e Saúde, Centro de Saúde Carlos Gomes, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Rua Carlos Gomes 270, 7° andar, Salvador, Bahia 40060-330 Brazil
| | - Sergio Telles de Oliva
- 3Laboratório de Química Analítica Ambiental, Departamento de Química Analítica, Instituto de Química, Universidade Federal da Bahia, Brazil, Rua Barão de Jeremoabo, 147. Campus de Ondina, Salvador, Bahia 40170-115 Brazil
| | - Raquel Cristina Lins Mota
- 4Serviço de Endoscopia Digestiva do Hospital das Clínicas de Universidade de São Paulo, PAMB, Prédio dos Ambulatórios, Av. Dr. Enéas Carvalho de Aguiar, 155 - 6°. Andar, Sala 3, São Paulo, SP CEP 05403-900 Brazil
| | - Valmar Bião de Lima
- 5Programa para o Controle da Asma na Bahia (ProAR), UFBA - Centro de Saúde Carlos Gomes, Rua Carlos Gomes 270, 7° andar, Salvador, Bahia 40060-330 Brazil
| | - Constança Sampaio Cruz
- Programa de Pós-Graduação em Medicina e Saúde Humana. Escola Bahiana de Medicina e Saúde Pública (EBMSP), Obras Sociais Irmã Dulce. Hospital Santo Antônio - Avenida Bonfim, 161 Largo de Roma, Salvador, Bahia 40420-415 Brazil
| | - José Miguel Chatkin
- 7Escola de Medicina da Pontifícia, Universidade Católica do Rio Grande do Sul, Brazil, Av. Ipiranga, 6690, Porto Alegre, Rio Grande do Sul 90610-000 Brazil
| | - Álvaro A Cruz
- 5Programa para o Controle da Asma na Bahia (ProAR), UFBA - Centro de Saúde Carlos Gomes, Rua Carlos Gomes 270, 7° andar, Salvador, Bahia 40060-330 Brazil
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16
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Shupler M, Godwin W, Frostad J, Gustafson P, Arku RE, Brauer M. Global estimation of exposure to fine particulate matter (PM 2.5) from household air pollution. ENVIRONMENT INTERNATIONAL 2018; 120:354-363. [PMID: 30119008 DOI: 10.1016/j.envint.2018.08.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND Exposure to household air pollution (HAP) from cooking with dirty fuels is a leading health risk factor within Asia, Africa and Central/South America. The concentration of particulate matter of diameter ≤ 2.5 μm (PM2.5) is an important metric to evaluate HAP risk, however epidemiological studies have demonstrated significant variation in HAP-PM2.5 concentrations at household, community and country levels. To quantify the global risk due to HAP exposure, novel estimation methods are needed, as financial and resource constraints render it difficult to monitor exposures in all relevant areas. METHODS A Bayesian, hierarchical HAP-PM2.5 global exposure model was developed using kitchen and female HAP-PM2.5 exposure data available in peer-reviewed studies from an updated World Health Organization Global HAP database. Cooking environment characteristics were selected using leave-one-out cross validation to predict quantitative HAP-PM2.5 measurements from 44 studies. Twenty-four hour HAP-PM2.5 kitchen concentrations and male, female and child exposures were estimated for 106 countries in Asia, Africa and Latin America. RESULTS A model incorporating fuel/stove type (traditional wood, improved biomass, coal, dung and gas/electric), urban/rural location, wet/dry season and socio-demographic index resulted in a Bayesian R2 of 0.57. Relative to rural kitchens using gas or electricity, the mean global 24-hour HAP-PM2.5 concentrations were 290 μg/m3 higher (range of regional averages: 110, 880) for traditional stoves, 150 μg/m3 higher (range of regional averages: 50, 290) for improved biomass stoves, 850 μg/m3 higher (range of regional averages: 310, 2600) for animal dung stoves, and 220 μg/m3 higher (range of regional averages: 80, 650) for coal stoves. The modeled global average female/kitchen exposure ratio was 0.40. Average modeled female exposures from cooking with traditional wood stoves were 160 μg/m3 in rural households and 170 μg/m3 in urban households. Average male and child rural area exposures from traditional wood stoves were 120 μg/m3 and 140 μg/m3, respectively; average urban area exposures were identical to average rural exposures among both sub-groups. CONCLUSIONS A Bayesian modeling approach was used to generate unique HAP-PM2.5 kitchen concentrations and personal exposure estimates for all countries, including those with little to no available quantitative HAP-PM2.5 exposure data. The global exposure model incorporating type of fuel-stove combinations can add specificity and reduce exposure misclassification to enable an improved global HAP risk assessment.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - William Godwin
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
| | - Joseph Frostad
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphael E Arku
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
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17
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Misra A, Longnecker MP, Dionisio KL, Bornman RMS, Travlos GS, Brar S, Whitworth KW. Household fuel use and biomarkers of inflammation and respiratory illness among rural South African Women. ENVIRONMENTAL RESEARCH 2018; 166:112-116. [PMID: 29885612 PMCID: PMC6110960 DOI: 10.1016/j.envres.2018.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/16/2018] [Accepted: 05/12/2018] [Indexed: 05/24/2023]
Abstract
Though literature suggests a positive association between use of biomass fuel for cooking and inflammation, few studies among women in rural South Africa exist. We included 415 women from the South African Study of Women and Babies (SOWB), recruited from 2010 to 2011. We obtained demographics, general medical history and usual source of cooking fuel (wood, electricity) via baseline questionnaire. A nurse obtained height, weight, blood pressure, and blood samples. We measured plasma concentrations of a suite of inflammatory markers (e.g., interleukins, tumor necrosis factor-α, C-reactive protein). We assessed associations between cooking fuel and biomarkers of inflammation and respiratory symptoms/illness using crude and adjusted linear and logistic regression models. We found little evidence of an association between fuel-use and biomarkers of inflammation, pre-hypertension/hypertension, or respiratory illnesses. Though imprecise, we found 41% (95% confidence interval (CI) = 0.72-2.77) higher odds of self-reported wheezing/chest tightness among wood-users compared with electricity-users. Though studies among other populations report positive findings between biomass fuel use and inflammation, it is possible that women in the present study experience lower exposures to household air pollution given the cleaner burning nature of wood compared with other biomass fuels (e.g., coal, dung).
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Affiliation(s)
- Ankita Misra
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health in San Antonio, San Antonio, TX, USA
| | - Matthew P Longnecker
- Epidemiology Branch, National Institute for Environmental Health Sciences, National Institutes of Health, DHHS, Research Triangle Park, NC, USA
| | - Kathie L Dionisio
- National Exposure Research Laboratory, Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Riana M S Bornman
- Department of Urology, University of Pretoria, Pretoria, South Africa; Cellular and Molecular Pathology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA; The University of Pretoria Centre for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa
| | - Gregory S Travlos
- Cellular and Molecular Pathology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA
| | - Sukhdev Brar
- Cellular and Molecular Pathology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA
| | - Kristina W Whitworth
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health in San Antonio, San Antonio, TX, USA; Southwest Center for Occupational and Environmental Health, UTHealth School of Public Health, Houston, TX, USA.
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18
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Shayo FK, Lutale J. Albuminuria in patients with chronic obstructive pulmonary disease: a cross-sectional study in an African patient cohort. BMC Pulm Med 2018; 18:125. [PMID: 30064397 PMCID: PMC6066916 DOI: 10.1186/s12890-018-0694-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/20/2018] [Indexed: 01/25/2023] Open
Abstract
Background Cardiovascular disease (CVD) is remarkably frequent in patients with chronic obstructive pulmonary disease (COPD). Albuminuria is a marker of vascular endothelial dysfunction and predictor of CVD events. Albuminuria is prevalent in patients with COPD as it has been shown in Caucasian and Oriental populations with COPD. The objective of this study was to determine the prevalence of Albuminuria and COPD severity correlates among black patients with chronic obstructive pulmonary disease in order to see whether a similar trend of albuminuria is also prevalent in this population. Methods A total of 104 COPD patients were enrolled in the study. Lung functions were assessed by means of the Easy One™ spirometer. Albuminuria defined by urine albumin to creatinine ratio (ACR) was tested using CYBOW 12MAC microalbumin strips in a random spot urine collection. SPSS version 20 was used for data analysis. Results In the studied population, 25/104 (24%) patients had albuminuria and 16/104 (15.4%) patients had CVD. Abnormal urine albumin (Albuminuria and Proteinuria) was present in all patients with CVD. In the subset of 46 COPD patients assessed for severity, 60.9% (95%CIs 46.1–73.9) had moderate COPD and 30.4% (95% CIs, 17.9–49.0) severe COPD. Albuminuria was moderately significantly associated with COPD severity, p = 0.049; (0.049 < p < 0.05). Participants who ever smoked cigarettes had significantly likelihood of severe and very severe COPD (OR 11.5; 95% CIs, 1.3, 98.4) however, the significance was lost when adjusted for age and gender. Conclusion Albuminuria was prevalent in patients with COPD and it had a significant association with COPD severity.
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Affiliation(s)
- Festo K Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O BOX 65001, Dar es Salaam, Tanzania. .,Department of Internal Medicine, Muhimbili National Hospital, P.o box 14087, Dar es Salaam, Tanzania. .,Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Janet Lutale
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O BOX 65001, Dar es Salaam, Tanzania. .,Department of Internal Medicine, Muhimbili National Hospital, P.o box 14087, Dar es Salaam, Tanzania.
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19
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Oguonu T, Obumneme-Anyim IN, Eze JN, Ayuk AC, Okoli CV, Ndu IK. Prevalence and determinants of airflow limitation in urban and rural children exposed to cooking fuels in South-East Nigeria. Paediatr Int Child Health 2018. [PMID: 29542392 DOI: 10.1080/20469047.2018.1445506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Biofuels and other cooking fuels are used in households in low- and middle-income countries. Aim To investigate the impact of cooking fuels on lung function in children in urban and rural households in South-East Nigeria. Methods The multi-stage sampling method was used to enroll children exposed to cooking fuel in the communities. Lung function values FEV1, FVC and the FEV1/FVC ratio, were measured with ndd EasyOneR spirometer. Airflow limitation was determined with FEV1/FVC Z-score values at -1.64 as the lower limit of normal (LLN5). The Global Lung Function Initiative 2012 software was used to calculate the lung function indices. Results The median age (range) of the 912 children enrolled was 10.6 years (6-18). Altogether, 468 (51.6%) children lived in rural areas. Seven hundred and thirty-seven (80.7%) were directly exposed to cooking fuels (418/737, 56.5% in rural areas). Wood and kerosene were the dominant fuels in rural and urban households. The respective mean Z-scores of the exposed children in rural and urban were zFEV1 -0.62, FVC -0.21, FEV1/FVC -0.83 and zFEV1 -0.57, zFVC -0.14, FEV1/FVC -0.75. Few (5.2%, 38/737) of the children had airflow limitation. Most of them (60.5%, 25/38) lived in the rural community; the lowest FEV1/FVC Z-scores were those of exposed to a combination of fuels. Conclusion Exposure to cooking fuels affects lung function in children with airway limitation in a small proportion, Control measures are advocated to reduce the morbidity related to cooking fuels exposure.
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Key Words
- ANOVA, analysis of variance
- ATS/ERS, American Thoracic Society and European Respiratory Society
- Airflow limitation
- BMI, body mass index
- DALY, disability-adjusted life years
- FER, forced expiratory ratio
- FEV1, forced expiratory volume in one second
- FEV1/FVC, forced expiratory volume in one second and forced vital capacity
- FEV6, forced expiratory volume in 6 s
- FVC, forced vital capacity
- GLI, global lung function initiative
- HAP, household air pollution
- IQR, interquartile ratio
- LLN, lower limit of normal
- LMS, Lambda–Mu–Sigma
- LPG, liquefied petroleum gas
- MA, Massachusetts
- NHANES III, Third National Health and Nutrition Examination Survey
- NHREC, Nigeria Health Research and Ethics Committee
- Nigeria
- PM, particulate matter
- SD, standard deviation
- SEC, socio-economic class
- SPSS, Statistical Package for Social Sciences
- WHO, World Health Organization
- children
- cooking fuel exposure
- lung function
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Affiliation(s)
- Tagbo Oguonu
- a Department of Paediatrics , University of Nigeria Teaching Hospital , Enugu State , Nigeria
| | - Ijeoma N Obumneme-Anyim
- a Department of Paediatrics , University of Nigeria Teaching Hospital , Enugu State , Nigeria
| | - Joy N Eze
- a Department of Paediatrics , University of Nigeria Teaching Hospital , Enugu State , Nigeria
| | - Adaeze C Ayuk
- a Department of Paediatrics , University of Nigeria Teaching Hospital , Enugu State , Nigeria.,b Paediatric Pulmonology firm , Red Cross War Memorial Children's Hospital , Cape Town , South Africa
| | - Chinyere V Okoli
- a Department of Paediatrics , University of Nigeria Teaching Hospital , Enugu State , Nigeria.,c Department of Paediatrics , Nyanya General Hospital , Abuja , Nigeria
| | - Ikenna K Ndu
- a Department of Paediatrics , University of Nigeria Teaching Hospital , Enugu State , Nigeria.,d Department of Paediatrics , Enugu State University of Science and Technology , Enugu , Nigeria
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Abstract
RATIONALE Black Africans have reduced FVC compared with white persons, but the prevalence and determinants of reduced values are not well understood. OBJECTIVES To evaluate the prevalence and factors leading to reduced FVC in a Nigerian population and to examine current theories regarding the determinants of this difference. METHODS We studied the ventilatory function of 883 adults aged 40 years or older participating in the Burden of Obstructive Lung Disease Study in Ile-Ife, Nigeria. Respondents completed pre- and post-bronchodilator spirometry test and provided information on their smoking history, respiratory symptoms, risk factors, and diagnoses, including anthropometric details. We used standard categories to define body mass index as either underweight, normal, overweight, or obese. We defined reduced FVC as a post-bronchodilator FVC below the lower limit of normal using National Health and Nutrition Examination Survey (NHANES) equations, Global Lung Function Initiative 2012 equations, and local reference equations based on nonsmoking study participants without a respiratory diagnosis. We fit multivariate linear regression models to FVC as a continuous measure, adjusting for age, sex, height, and other confounders. RESULTS The prevalence of reduced FVC was 70.4% for men and 72.8% for women when using NHANES values for white Americans, 17.8% for men and 14.4% for women using NHANES equations for African Americans, and 15.5% for men and 20.5% for women using the Global Lung Function Initiative 2012 equations. Using the equations derived from nonsmoking respondents in the survey without a respiratory diagnosis, the prevalence of reduced FVC was less than 4% for both men and women. FVC was lower in participants who had less than 7 years of education (FVC, -96 ml; 95% confidence interval [CI], -172 to -19), were underweight (FVC, -269 ml; 95% CI, -464 to -73), were overweight (FVC, -132 ml; 95% CI, -219 to -46), and were obese (FVC, -222 ml; 95% CI, -332 to -112). CONCLUSIONS There is a wide variation in the prevalence of reduced FVC based on the reference standard used. This variation is not satisfactorily explained by factors thought to affect FVC within individual populations. However, the prevalence strongly associates with both education level and body mass index in this population, regardless of the specific standard used.
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21
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Amaral AFS, Patel J, Kato BS, Obaseki DO, Lawin H, Tan WC, Juvekar SK, Harrabi I, Studnicka M, Wouters EFM, Loh LC, Bateman ED, Mortimer K, Buist AS, Burney PGJ. Airflow Obstruction and Use of Solid Fuels for Cooking or Heating: BOLD Results. Am J Respir Crit Care Med 2018; 197:595-610. [PMID: 28895752 PMCID: PMC6005234 DOI: 10.1164/rccm.201701-0205oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Evidence supporting the association of COPD or airflow obstruction with use of solid fuels is conflicting and inconsistent. OBJECTIVE To assess the association of airflow obstruction with self-reported use of solid fuels for cooking or heating. METHODS We analysed 18,554 adults from the BOLD study, who had provided acceptable post-bronchodilator spirometry measurements and information on use of solid fuels. The association of airflow obstruction with use of solid fuels for cooking or heating was assessed by sex, within each site, using regression analysis. Estimates were stratified by national income and meta-analysed. We carried out similar analyses for spirometric restriction, chronic cough and chronic phlegm. MEASUREMENTS AND MAIN RESULTS We found no association between airflow obstruction and use of solid fuels for cooking or heating (ORmen=1.20, 95%CI 0.94-1.53; ORwomen=0.88, 95%CI 0.67-1.15). This was true for low/middle and high income sites. Among never smokers there was also no evidence of an association of airflow obstruction with use of solid fuels (ORmen=1.00, 95%CI 0.57-1.76; ORwomen=1.00, 95%CI 0.76-1.32). Overall, we found no association of spirometric restriction, chronic cough or chronic phlegm with the use of solid fuels. However, we found that chronic phlegm was more likely to be reported among female never smokers and those who had been exposed for ≥20 years. CONCLUSION Airflow obstruction assessed from post-bronchodilator spirometry was not associated with use of solid fuels for cooking or heating.
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Affiliation(s)
- André F S Amaral
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland ;
| | - Jaymini Patel
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland ;
| | - Bernet S Kato
- Imperial College London, 4615, London, London, United Kingdom of Great Britain and Northern Ireland ;
| | | | - Hervé Lawin
- Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey - Calavi , Cotonou, Benin, Cotonou, Benin ;
| | - Wan C Tan
- Univ British Columbia, icapture center, Vancouver, British Columbia, Canada ;
| | - Sanjay K Juvekar
- Vadu Health and Demographic Surveillance System and Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India ;
| | - Imed Harrabi
- Faculty of Medicine, Sousse, Tunisia, Sousse, Tunisia ;
| | | | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands ;
| | - Li-Cher Loh
- Penang Medical College, 26696, Georgetown, Pulau Pinang, Malaysia ;
| | | | - Kevin Mortimer
- Liverpool School of Tropical Medicine, 9655, Liverpool, United Kingdom of Great Britain and Northern Ireland ;
| | - A Sonia Buist
- Oregon Health Sciences University, Medicine / Pulmonary & Critical Care, Portland, Oregon, United States ;
| | - Peter G J Burney
- Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland ;
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22
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Jones R. The scale of the problem of obstructive lung disease in Africa becomes clearer, but where are the solutions? Eur Respir J 2018; 51:51/2/1702562. [PMID: 29386341 DOI: 10.1183/13993003.02562-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Rupert Jones
- Peninsula School of Medicine, Plymouth University, Plymouth, UK
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23
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Rajaee M, Yee AK, Long RN, Renne EP, Robins TG, Basu N. Pulmonary function and respiratory health of rural farmers and artisanal and small scale gold miners in Ghana. ENVIRONMENTAL RESEARCH 2017; 158:522-530. [PMID: 28710986 PMCID: PMC5609509 DOI: 10.1016/j.envres.2017.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/08/2017] [Accepted: 07/05/2017] [Indexed: 06/07/2023]
Abstract
The recent increase in artisanal and small scale gold mining (ASGM) worldwide has elicited a number of public health concerns for miners and mining communities, including respiratory health. The two primary inhalational exposures of concern are crystalline silica expected to be present in gold ore and smoke from biomass fuels used in cooking. Here, measurements of pulmonary function and of respiratory symptoms were performed in an ASGM community, Kejetia, and a comparison agricultural community, Gorogo, in the Upper East Region of Ghana in May-July 2011. Of 172 participants, 159 performed spirometry, yielding 119 and 95 valid measurements for FEV1 and FVC, respectively. Percent predicted FEV1, FVC and FEV1/FVC, which were lower than predicted for a healthy population, were not significantly different between Kejetia and Gorogo or by mining status in Kejetia. Abnormal lung function was elevated for predicted FEV1 (15.0%) and FEV1/FVC (22.0%) beyond an expected five percent in healthy populations. This first examination of pulmonary function in an ASGM community in Ghana (and possibly worldwide) did not show an obvious relationship between mining involvement and lung function abnormality, but did show associations between the use of biomass fuels, adverse respiratory symptoms, and reduced pulmonary function in both populations. A number of factors including age differences between the populations and the required lag time after silica exposure for the onset of respiratory disease may have affected results. Additional research is needed with larger sample sizes and with more detailed questionnaires to further assess the impact of multiple stressors on respiratory health in ASGM communities.
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Affiliation(s)
- Mozhgon Rajaee
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA; School of Health Sciences, Oakland University, Rochester, MI 48309-4452, USA.
| | - Allison K Yee
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA; School of Health Sciences, Oakland University, Rochester, MI 48309-4452, USA.
| | - Rachel N Long
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA; School of Health Sciences, Oakland University, Rochester, MI 48309-4452, USA.
| | - Elisha P Renne
- School of Health Sciences, Oakland University, Rochester, MI 48309-4452, USA; Department of Anthropology, University of Michigan, Ann Arbor, MI 48109-1107, USA; Department of Afroamerican and African Studies, University of Michigan, Ann Arbor, MI48109-1107, USA.
| | - Thomas G Robins
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA; School of Health Sciences, Oakland University, Rochester, MI 48309-4452, USA.
| | - Niladri Basu
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA; Faculty of Agricultural and Environmental Sciences, McGill University, Ste. Anne de Bellevue, Quebec, Canada H9X 3V9.
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24
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Awopeju OF, Nemery B, Afolabi OT, Poels K, Vanoirbeek J, Obaseki DO, Adewole OO, Lawin HA, Vollmer W, Erhabor GE. Biomass smoke exposure as an occupational risk: cross-sectional study of respiratory health of women working as street cooks in Nigeria. Occup Environ Med 2017; 74:737-744. [PMID: 28780568 DOI: 10.1136/oemed-2016-104107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Little is known about respiratory health of women who are occupationally exposed to biomass smoke outside their homes. This study reports the exposure and respiratory health of street cooks in Ile-Ife, Nigeria. METHODS We assessed exposure to biomass smoke by questionnaire in 188 street cooks and 197 control women and by personal diffusive samplers to quantify volatile organic compounds (VOCs) in a subsample of the women. Respiratory symptoms were assessed by a standardised questionnaire, and pulmonary function was assessed by spirometry before and after bronchodilation. Regression analysis was conducted to compare the outcome between the two groups. RESULTS The study included 188 women (median age 40, IQR 30-50 years) who had worked as street cooks for a median of 7 years (IQR 3-15 years) and 197 control women with similar demographics. Benzene concentration in passive samplers worn by the street cooks was significantly higher compared with controls (median (IQR) 119.3 (82.7-343.7) µg/m3 vs 0.0 (0.0-51.2) µg/m3, p<0.001). The odds of reported respiratory symptoms were significantly higher among the street cooks than controls: cough (adjusted OR 4.4, 95% CI 2.2 to 8.5) and phlegm (adjusted OR 3.9, 95% CI 1.5 to 7.3). The street cooks also had higher odd of airway obstruction as measured by forced expiratory volume in 1 s/forced vital capacity <0.7: 11% 3% (adjusted OR of 3.3 (95% CI 1.3 to 8.7)). CONCLUSIONS This study provides evidence of adverse respiratory effects among street cooks using biomass fuels.
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Affiliation(s)
| | - Benoit Nemery
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | | | - Katrien Poels
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Jeroen Vanoirbeek
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | | | | | - Hervé Anicet Lawin
- Department of Public Health, Unit of Teaching and Research in Occupational and Environmental Health, University of Abomey-Calavi, Cotonou, Benin
| | - William Vollmer
- Centre for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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25
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Devkota S, Anderson B, Soiza RL, Myint PK. Prevalence and determinants of frailty and associated comorbidities among older Gurkha welfare pensioners in Nepal. Geriatr Gerontol Int 2017; 17:2493-2499. [DOI: 10.1111/ggi.13113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/13/2017] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Sirjana Devkota
- Ageing Clinical and Experimental Research (ACER) Team; Institute of Applied Health Sciences, University of Aberdeen; UK
| | | | - Roy L. Soiza
- Health Services Research Unit; Institute of Applied Health Sciences, University of Aberdeen; UK
- Academic Department of Medicine for the Elderly, NHS Grampian; Aberdeen UK
| | - Phyo K. Myint
- Ageing Clinical and Experimental Research (ACER) Team; Institute of Applied Health Sciences, University of Aberdeen; UK
- Academic Department of Medicine for the Elderly, NHS Grampian; Aberdeen UK
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26
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McCarthy CE, Duffney PF, Gelein R, Thatcher TH, Elder A, Phipps RP, Sime PJ. Dung biomass smoke activates inflammatory signaling pathways in human small airway epithelial cells. Am J Physiol Lung Cell Mol Physiol 2016; 311:L1222-L1233. [PMID: 27836898 DOI: 10.1152/ajplung.00183.2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/03/2016] [Indexed: 11/22/2022] Open
Abstract
Animal dung is a biomass fuel burned by vulnerable populations who cannot afford cleaner sources of energy, such as wood and gas, for cooking and heating their homes. Exposure to biomass smoke is the leading environmental risk for mortality, with over 4,000,000 deaths each year worldwide attributed to indoor air pollution from biomass smoke. Biomass smoke inhalation is epidemiologically associated with pulmonary diseases, including chronic obstructive pulmonary disease (COPD), lung cancer, and respiratory infections, especially in low and middle-income countries. Yet, few studies have examined the mechanisms of dung biomass smoke-induced inflammatory responses in human lung cells. Here, we tested the hypothesis that dung biomass smoke causes inflammatory responses in human lung cells through signaling pathways involved in acute and chronic lung inflammation. Primary human small airway epithelial cells (SAECs) were exposed to dung smoke at the air-liquid interface using a newly developed, automated, and reproducible dung biomass smoke generation system. The examination of inflammatory signaling showed that dung biomass smoke increased the production of several proinflammatory cytokines and enzymes in SAECs through activation of the activator protein (AP)-1 and arylhydrocarbon receptor (AhR) but not nuclear factor-κB (NF-κB) pathways. We propose that the inflammatory responses of lung cells exposed to dung biomass smoke contribute to the development of respiratory diseases.
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Affiliation(s)
- Claire E McCarthy
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Lung Biology and Disease Program, University of Rochester, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Parker F Duffney
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Lung Biology and Disease Program, University of Rochester, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Robert Gelein
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Thomas H Thatcher
- Division of Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; and.,Lung Biology and Disease Program, University of Rochester, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Alison Elder
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Lung Biology and Disease Program, University of Rochester, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Richard P Phipps
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Division of Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; and.,Lung Biology and Disease Program, University of Rochester, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Patricia J Sime
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; .,Division of Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; and.,Lung Biology and Disease Program, University of Rochester, University of Rochester School of Medicine and Dentistry, Rochester, New York
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27
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Khayath N, Qi S, de Blay F. Bronchopneumopathie chronique obstructive (BPCO) et environnement intérieur. Rev Mal Respir 2016; 33:666-674. [DOI: 10.1016/j.rmr.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW Approximately 3 billion people worldwide rely on coal and biomass fuel for cooking and heating. Biomass smoke exposure is associated with several chronic lung diseases, including chronic obstructive pulmonary disease (COPD), asthma-COPD overlap syndrome, usual interstitial pneumonitis, hut lung, and bronchial anthracofibrosis. Household air pollution primarily from biomass smoke is the biggest risk factor for COPD worldwide. Despite the significant burden of biomass smoke-related respiratory disease, the exposure is still underappreciated worldwide, especially in high-income countries. RECENT FINDINGS Recent literature highlights the immunoinflammatory differences between biomass smoke-related COPD and tobacco smoke-related COPD that may lead to better understanding of the differences in the clinical phenotypes between the two entities, suggests an association with the recently recognized asthma-COPD overlap syndrome, and elucidates the burden of disease in high-income countries. SUMMARY The current review focuses on the association between biomass smoke and common chronic respiratory diseases, discuss differences between biomass smoke-related COPD and tobacco smoke-related COPD, highlights chronic respiratory diseases that are specific for biomass smoke exposure such as hut lung and bronchial anthracofibrosis, and discusses the known impact of beneficial interventions.
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FRESH AIR: an implementation research project funded through Horizon 2020 exploring the prevention, diagnosis and treatment of chronic respiratory diseases in low-resource settings. NPJ Prim Care Respir Med 2016; 26:16035. [PMID: 27356621 PMCID: PMC4928382 DOI: 10.1038/npjpcrm.2016.35] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 01/21/2023] Open
Abstract
This protocol describes FRESH AIR, an implementation science project exploring how to improve the prevention, diagnosis and treatment of chronic lung diseases in contexts with limited healthcare resources. It consists of inter-related studies that take place in four countries that are part of the International Primary Care Respiratory Group’s (IPCRG) global network: Uganda, the Kyrgyz Republic, Vietnam and Greece. The project has been funded by the European Commission Horizon 2020 research programme and runs from October 2015 until September 2018.
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Respiratory Effects of High Levels of Particulate Exposure in a Cohort of Traffic Police in Kathmandu, Nepal. J Occup Environ Med 2016; 58:e218-25. [DOI: 10.1097/jom.0000000000000753] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li Z, Trinidad D, Pittman EN, Riley EA, Sjodin A, Dills RL, Paulsen M, Simpson CD. Urinary polycyclic aromatic hydrocarbon metabolites as biomarkers to woodsmoke exposure - results from a controlled exposure study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2016; 26:241-8. [PMID: 25605446 PMCID: PMC4532642 DOI: 10.1038/jes.2014.94] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/12/2014] [Accepted: 11/15/2014] [Indexed: 05/13/2023]
Abstract
Woodsmoke contains harmful components - such as fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAHs) - and impacts more than half of the global population. We investigated urinary hydroxylated PAH metabolites (OH-PAHs) as woodsmoke exposure biomarkers in nine non-smoking volunteers experimentally exposed to a wood fire. Individual urine samples were collected from 24-h before to 48-h after the exposure and personal PM2.5 samples were collected during the 2-h woodsmoke exposure. Concentrations of nine OH-PAHs increased by 1.8-7.2 times within 2.3-19.3 h, and returned to baseline approximately 24 h after the exposure. 2-Naphthol (2-NAP) had the largest post-exposure increase and exhibited a clear excretion pattern in all participants. The level of urinary OH-PAHs, except 1-hydroxypyrene (1-PYR), correlated with those of PM2.5, levoglucosan and PAHs in personal PM2.5 samples. This finding suggests that several urinary OH-PAHs, especially 2-NAP, are potential exposure biomarkers to woodsmoke; by contrast, 1-PYR may not be a suitable biomarker. Compared with levoglucosan and methoxyphenols - two other urinary woodsmoke biomarkers that were measured in the same study and reported previously - OH-PAHs might be better biomarkers based on sensitivity, robustness and stability, particularly under suboptimal sampling and storage conditions, like in epidemiological studies carried out in less developed areas.
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Affiliation(s)
- Zheng Li
- National Center for Environmental Health, Centers for Disease Control and Prevention
- Corresponding Author: Zheng Li, Ph.D., National Center for Environmental Health, Center for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, , Phone: +1) 770-488-7940
| | - Debra Trinidad
- National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Erin N. Pittman
- National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Erin A. Riley
- Department of Environmental and Occupational Health Sciences, University of Washington
| | - Andreas Sjodin
- National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Russell L. Dills
- Department of Environmental and Occupational Health Sciences, University of Washington
| | - Michael Paulsen
- Department of Environmental and Occupational Health Sciences, University of Washington
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Solid fuel in kitchen and acute respiratory tract infection among under five children: evidence from Nepal demographic and health survey 2011. J Community Health 2016; 40:515-21. [PMID: 25388626 DOI: 10.1007/s10900-014-9965-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assessed the association between use of solid fuel in kitchen and ARI among under five children in Nepal. The latest data from the Nepal Demographic and Health Survey 2011 were used. A total of 4,802 under 5 de-jure children were included in this analysis. Cough accompanied by short/rapid breath and chest problem within 2 weeks before survey was considered as the symptoms of ARI. Logistic regression analysis was performed to calculate the odds of being suffered from ARI among the children from households using solid fuel in comparison to the children from households using cleaner fuel. About 84.6% of the families used solid fuel as a primary fuel. Approximately 4.5% children had symptoms of ARI within 2 weeks before the survey. About 3.4 and 4.9% of children from the families using cleaner fuel and solid fuel respectively had symptoms of ARI within 2 weeks preceding survey. After adjusting for age, sex, birth order, urban/rural residence, ecological zone, development region, economic status, number of family members, mother's smoking status and mother's education, odds of suffering from ARI was 1.79 times higher among the children from the households using solid fuel in comparison to the children from households using cleaner fuel (95% CI 1.02, 3.14). This study found the use of solid fuel in the kitchen has as a risk factor for ARI among under five children in Nepal. Longitudinal studies with direct measurement of indoor air pollution and clinical ARI cases can be future research priority.
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El-Essawy AF, Ali MA, Al-Sherbiny NA, Elhefny RA, Farhat ES. Chronic obstructive pulmonary disease among women using biomass fuels in some rural areas of Fayoum governorate. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2015. [DOI: 10.4103/1687-8426.165891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
The term “immune” pertains to the body keeping itself free from diseases, not to trigger any diseases. In this regard, it makes sense for us to divide antigenicity into immunogenicity and allergenicity. This distinction allows for the characterization of all types of modern antigens, i.e., to evaluate and modify a priori the allergenicity of an antigen before it is applied to humans. In this chapter, we also formulated the hypothesis that “Balanced Stimulation by Whole Antigens” is essential for immune development. This hypothesis revives the practicality of the “Hygiene Hypothesis” and can provide a fundamental solution to curb the increasing prevalence of allergic disease, namely, early exposure, at 0–1 year old or earlier, in utero, of representative allergens/protein antigens with immunogenicity retained or improved and allergenicity attenuated or eliminated.
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Obaseki DO, Erhabor GE, Gnatiuc L, Adewole OO, Buist SA, Burney PG. Chronic Airflow Obstruction in a Black African Population: Results of BOLD Study, Ile-Ife, Nigeria. COPD 2015; 13:42-9. [PMID: 26451840 DOI: 10.3109/15412555.2015.1041102] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Global estimates suggest that Chronic Obstructive Pulmonary Disease (COPD) is emerging as a leading cause of death in developing countries but there are few spirometry-based general population data on its prevalence and risk factors in sub-Saharan Africa. We used the Burden of Obstructive Lung Disease (BOLD) protocol to select a representative sample of adults aged 40 years and above in Ile-Ife, Nigeria. All the participants underwent spirometry and provided information on smoking history, biomass and occupational exposures as well as diagnosed respiratory diseases and symptoms. Chronic Airflow Obstruction (CAO) was defined as the ratio of post-bronchodilator (BD) one second Forced Expiratory Volume (FEV1) to Forced Vital Capacity (FVC) below the lower limit of normal (LLN) of the population distribution for FEV1/FVC. The overall prevalence of obstruction (post-BD FEV1/FVC < LLN) was 7.7% (2.7% above LLN) using Global Lung Function Initiative (GLI) equations. It was associated with few respiratory symptoms; 0.3% reported a previous doctor-diagnosed chronic bronchitis, emphysema or COPD. Independent predictors included a lack of education (OR 2.5, 95% CI: 1.0, 6.4) and a diagnosis of either TB (OR 23.4, 95% CI: 2.0, 278.6) or asthma (OR 35.4, 95%CI: 4.9, 255.8). There was no association with the use of firewood or coal for cooking or heating. The vast majority of this population (89%) are never smokers. We conclude that the prevalence of CAO is low in Ile-Ife, Nigeria and unrelated to biomass exposure. The key independent predictors are poor education, and previous diagnosis of tuberculosis or asthma.
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Affiliation(s)
- Daniel O Obaseki
- a 1 Department of Medicine , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Gregory E Erhabor
- a 1 Department of Medicine , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Louisa Gnatiuc
- b 2 National Heart and Lung Institute, Imperial College , London , United Kingdom
| | - Olufemi O Adewole
- a 1 Department of Medicine , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Sonia A Buist
- c 3 Division of Pulmonary and Critical Care, Oregon Health and Sciences University , Portland , Oregon , USA
| | - Peter G Burney
- b 2 National Heart and Lung Institute, Imperial College , London , United Kingdom
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Nasanen-Gilmore SPK, Saha S, Rasul I, Rousham EK. Household environment and behavioral determinants of respiratory tract infection in infants and young children in northern Bangladesh. Am J Hum Biol 2015; 27:851-8. [PMID: 25994352 DOI: 10.1002/ajhb.22736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/06/2015] [Accepted: 04/21/2015] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Respiratory tract infections (RTI) are one of the leading causes of under-five mortality in Bangladesh. Solid biomass fuels are the main source of domestic fuel used for cooking across Bangladesh, leading to smoke and pollution exposure in the home. This article aims to identify risk factors for RTI among children aged under five years in Bangladesh with a particular focus on the household environment, fuel use, and cooking practices. METHODS A cross-sectional household-health survey was carried out in 321 households in northern Bangladesh. The survey included care-giver interviews on cooking practices, child health, and household behaviors during cooking. Health status of the youngest child (under five years) from each household was recorded through maternal interviews, medical diagnosis, and assessment of biomarkers (C-reactive protein (CRP), hemoglobin) from finger-prick blood samples. Anthropometric status (weight, height) was recorded. RESULTS Children who spent ≥30 minutes/day within 5 feet of the stove during cooking had a significantly increased risk of moderate/severe RTI compared with children spending <30 minutes/day close to the stove (OR = 2.15, 95%CI: 1.20-3.86, P = 0.01), independent of socio-economic status (SES), biomass fuel type (wood, dung, plant-derived, compressed rice husks), child age, anthropometric status, CRP and hemoglobin. CONCLUSIONS In environments with a heavy reliance on solid biomass fuels, the amount of time a child spends near the stove during cooking may be an important risk for RTI. These novel findings from Bangladesh warrant further investigation of mother-infant behaviors during cooking in relation to child health, to ascertain whether the association is likely to be causal.
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Affiliation(s)
| | - Subir Saha
- Office of School Wellness Programs, New York City Department of Education, New York
| | - Izaz Rasul
- Concern Worldwide, Bangladesh, Gulshan 1, Dhaka, Bangladesh
| | - Emily K Rousham
- Centre for Global Health and Human Development, School of Sports, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
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Mt Everest Base Camp Medical Clinic “Everest ER”: Epidemiology of Medical Events During the First 10 Years of Operation. Wilderness Environ Med 2015; 26:4-10. [DOI: 10.1016/j.wem.2014.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 06/24/2014] [Accepted: 07/21/2014] [Indexed: 11/24/2022]
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Devakumar D, Stocks J, Ayres JG, Kirkby J, Yadav SK, Saville NM, Devereux G, Wells JCK, Manandhar DS, Costello A, Osrin D. Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal. Eur Respir J 2015; 45:1566-75. [PMID: 25700386 DOI: 10.1183/09031936.00188914] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/12/2014] [Indexed: 12/20/2022]
Abstract
A randomised trial of prenatal multiple micronutrient supplementation in Nepalese women increased birthweight and weight at 2 years of age in offspring, compared to those born to mothers who only received iron and folic acid supplements. Further follow-up of this cohort provided an opportunity to investigate the effect of antenatal multiple micronutrients on subsequent lung function by measuring spirometry at 7-9 years of age in C: hildren born during the trial. 841 children (80% of the cohort) were seen at mean±sd 8.5±0.4 years. Technically successful spirometry results were obtained in 793 (94.3%) children, 50% of whom had been randomised to micronutrient supplementation. Background characteristics, including anthropometry, were similar in the two allocation groups. Lung function was also similar, mean (95% CI) difference in z-scores (supplementation minus control) was -0.08 (-0.19-0.04), -0.05 (-0.17-0.06) and -0.04 (-0.15-0.07) for forced expiratory volume in 1 s (FEV1), forced vital capacity and FEV1/FVC, respectively. Compared with healthy white children, FEV1 and FVC in the "healthy" Nepalese children were ∼1 (∼13%) z-score lower, with no difference in FEV1/FVC. We conclude that, compared with routine iron and folic acid, multiple micronutrient supplementation during pregnancy has no effect on spirometric lung function in Nepalese children at 8.5 years of age.
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Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London, UK.
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia Section (Portex Unit), Institute of Child Health, University College London, London, UK
| | - Jon G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Jane Kirkby
- Respiratory, Critical Care and Anaesthesia Section (Portex Unit), Institute of Child Health, University College London, London, UK. Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Naomi M Saville
- Institute for Global Health, University College London, London, UK
| | - Graham Devereux
- Child Health Dept, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, Institute of Child Health, University College London, London, UK
| | | | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - David Osrin
- Institute for Global Health, University College London, London, UK
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Neupane M, Basnyat B, Fischer R, Froeschl G, Wolbers M, Rehfuess EA. Sustained use of biogas fuel and blood pressure among women in rural Nepal. ENVIRONMENTAL RESEARCH 2015; 136:343-51. [PMID: 25460655 PMCID: PMC4271778 DOI: 10.1016/j.envres.2014.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/18/2014] [Accepted: 10/15/2014] [Indexed: 05/16/2023]
Abstract
BACKGROUND More than two fifths of the world's population cook with solid fuels and are exposed to household air pollution (HAP). As of now, no studies have assessed whether switching to alternative fuels like biogas could impact cardiovascular health among cooks previously exposed to solid fuel use. METHODS We conducted a propensity score matched cross-sectional study to explore if the sustained use of biogas fuel for at least ten years impacts blood pressure among adult female cooks of rural Nepal. We recruited one primary cook ≥ 30 years of age from each biogas (219 cooks) and firewood (300 cooks) using household and measured their systolic (SBP) and diastolic blood pressure (DBP). Household characteristics, kitchen ventilation and 24-h kitchen carbon monoxide were assessed. We matched cooks by age, body mass index and socio-economic status score using propensity scores and investigated the effect of biogas use through multivariate regression models in two age groups, 30-50 years and >50 years to account for any post-menopausal changes. RESULTS We found substantially reduced 24-h kitchen carbon monoxide levels among biogas-using households. After matching and adjustment for smoking, kitchen characteristics, ventilation status and additional fuel use, the use of biogas was associated with 9.8 mmHg lower SBP [95% confidence interval (CI), -20.4 to 0.8] and 6.5 mmHg lower DBP (95% CI, -12.2 to -0.8) compared to firewood users among women >50 years of age. In this age group, biogas use was also associated with 68% reduced odds [Odds ratio 0.32 (95% CI, 0.14 to 0.71)] of developing hypertension. These effects, however, were not identified in younger women aged 30-50 years. CONCLUSIONS Sustained use of biogas for cooking may protect against cardiovascular disease by lowering the risk of high blood pressure, especially DBP, among older female cooks. These findings need to be confirmed in longitudinal or experimental studies.
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Affiliation(s)
- Maniraj Neupane
- Center for International Health, Ludwig-Maximilians-Universitaet, Munich, Germany; Mountain Medicine Society of Nepal, Kathmandu, Nepal.
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Hospital, Kathmandu, Nepal
| | - Rainald Fischer
- Center for International Health, Ludwig-Maximilians-Universitaet, Munich, Germany
| | - Guenter Froeschl
- Center for International Health, Ludwig-Maximilians-Universitaet, Munich, Germany
| | - Marcel Wolbers
- The Hospital for Tropical Disease, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit-Vietnam, Ho Chi Minh City, Vietnam
| | - Eva A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universitaet, Munich, Germany
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Kurmi OP, Semple S, Devereux GS, Gaihre S, Lam KBH, Sadhra S, Steiner MFC, Simkhada P, Smith WCS, Ayres JG. The effect of exposure to biomass smoke on respiratory symptoms in adult rural and urban Nepalese populations. Environ Health 2014; 13:92. [PMID: 25374400 PMCID: PMC4232609 DOI: 10.1186/1476-069x-13-92] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/28/2014] [Indexed: 05/22/2023]
Abstract
BACKGROUND Half of the world's population is exposed to household air pollution from biomass burning. This study aimed to assess the relationship between respiratory symptoms and biomass smoke exposure in rural and urban Nepal. METHODS A cross-sectional study of adults (16+ years) in a rural population (n = 846) exposed to biomass smoke and a non-exposed urban population (n = 802) in Nepal. A validated questionnaire was used along with measures of indoor air quality (PM2.5 and CO) and outdoor PM2.5. RESULTS Both men and women exposed to biomass smoke reported more respiratory symptoms compared to those exposed to clean fuel. Women exposed to biomass were more likely to complain of ever wheeze (32.0 % vs. 23.5%; p = 0.004) and breathlessness (17.8% vs. 12.0%, p = 0.017) compared to males with tobacco smoking being a major risk factor. Chronic cough was similar in both the biomass and non-biomass smoke exposed groups whereas chronic phlegm was reported less frequently by participants exposed to biomass smoke. Higher PM2.5 levels (≥2 SDs of the 24-hour mean) were associated with breathlessness (OR = 2.10, 95% CI 1.47, 2.99) and wheeze (1.76, 1.37, 2.26). CONCLUSIONS The study suggests that while those exposed to biomass smoke had higher prevalence of respiratory symptoms, urban dwellers (who were exposed to higher ambient air pollution) were more at risk of having productive cough.
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Affiliation(s)
- Om P Kurmi
- />Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF UK
| | - Sean Semple
- />Scottish Centre for Indoor Air, Division of Applied Health Sciences, School of Medicine, University of Aberdeen, Aberdeen, AB24 3FX UK
| | - Graham S Devereux
- />Department of Child Health, Royal Aberdeen Children’s Hospital, University of Aberdeen, Aberdeen, AB25 2ZG UK
| | - Santosh Gaihre
- />Scottish Centre for Indoor Air, Division of Applied Health Sciences, School of Medicine, University of Aberdeen, Aberdeen, AB24 3FX UK
| | - Kin Bong Hubert Lam
- />Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, B15 2TT UK
| | - Steven Sadhra
- />Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, B15 2TT UK
| | - Markus FC Steiner
- />Scottish Centre for Indoor Air, Division of Applied Health Sciences, School of Medicine, University of Aberdeen, Aberdeen, AB24 3FX UK
| | - Padam Simkhada
- />School of Health and Related Research, University of Sheffield, Sheffield, S10 2TN UK
| | - William CS Smith
- />School of Medicine and Dentistry, University of Aberdeen, Aberdeen, AB24 3FX UK
| | - Jon G Ayres
- />Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, B15 2TT UK
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Kurmi OP, Dunster C, Ayres JG, Kelly FJ. Oxidative potential of smoke from burning wood and mixed biomass fuels. Free Radic Res 2014; 47:829-35. [PMID: 23926954 DOI: 10.3109/10715762.2013.832831] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
More than half the world's population still rely on burning biomass fuels to heat and light their homes and cook food. Household air pollution, a common component of which is inhalable particulate matter (PM), emitted from biomass burning is associated with increased vulnerability to respiratory infection and an enhanced risk of developing chronic obstructive pulmonary disease. In the light of an emerging hypothesis linking chronic PM exposure during childhood and increased vulnerability to respiratory diseases in adulthood, in a chain of events involving oxidative stress, reduced immunity and subsequent infection, the aim of this study was to characterise the oxidative potential (OP) of PM collected during the burning of wood and mixed biomass, whilst cooking food in the Kathmandu Valley, Nepal. Our assessments were based on the capacity of the particles to deplete the physiologically relevant antioxidants from a validated, synthetic respiratory tract lining fluid (RTLF). Incubation of mixed biomass and wood smoke particles suspensions with the synthetic RTLF for 4 h resulted in a mean loss of ascorbate of 64.76 ± 16.83% and 83.37 ± 14.12% at 50 μg/ml, respectively. Reduced glutathione was depleted by 49.29 ± 15.22% in mixed biomass and 65.33 ± 13.01% in wood smoke particles under the same conditions. Co-incubation with the transition metal chelator diethylenetriaminepentaacetate did not inhibit the rate of ascorbate oxidation, indicating a negligible contribution by redox-active metals in these samples. The capacity of biomass smoke particles to elicit oxidative stress certainly has the potential to contribute towards negative health impacts associated with traditional domestic fuels in the developing world.
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Affiliation(s)
- O P Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford , Oxford , UK
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Devakumar D, Semple S, Osrin D, Yadav SK, Kurmi OP, Saville NM, Shrestha B, Manandhar DS, Costello A, Ayres JG. Biomass fuel use and the exposure of children to particulate air pollution in southern Nepal. ENVIRONMENT INTERNATIONAL 2014; 66:79-87. [PMID: 24533994 PMCID: PMC3989062 DOI: 10.1016/j.envint.2014.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 01/15/2014] [Accepted: 01/17/2014] [Indexed: 05/05/2023]
Abstract
The exposure of children to air pollution in low resource settings is believed to be high because of the common use of biomass fuels for cooking. We used microenvironment sampling to estimate the respirable fraction of air pollution (particles with median diameter less than 4 μm) to which 7-9 year old children in southern Nepal were exposed. Sampling was conducted for a total 2649 h in 55 households, 8 schools and 8 outdoor locations of rural Dhanusha. We conducted gravimetric and photometric sampling in a subsample of the children in our study in the locations in which they usually resided (bedroom/living room, kitchen, veranda, in school and outdoors), repeated three times over one year. Using time activity information, a 24-hour time weighted average was modeled for all the children in the study. Approximately two-thirds of homes used biomass fuels, with the remainder mostly using gas. The exposure of children to air pollution was very high. The 24-hour time weighted average over the whole year was 168 μg/m(3). The non-kitchen related samples tended to show approximately double the concentration in winter than spring/autumn, and four times that of the monsoon season. There was no difference between the exposure of boys and girls. Air pollution in rural households was much higher than the World Health Organization and the National Ambient Air Quality Standards for Nepal recommendations for particulate exposure.
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Affiliation(s)
- D Devakumar
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK.
| | - S Semple
- University of Aberdeen Scottish Centre for Indoor Air, Division of Applied Health Sciences, Royal Aberdeen Children's Hospital, Westburn Road, Aberdeen AB25 2ZD, UK
| | - D Osrin
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - S K Yadav
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - O P Kurmi
- Clinical Trial Services Unit and Epidemiological Studies Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - N M Saville
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - B Shrestha
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - D S Manandhar
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - A Costello
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - J G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Umoh VA, Peters E. The relationship between lung function and indoor air pollution among rural women in the Niger Delta region of Nigeria. Lung India 2014; 31:110-5. [PMID: 24778471 PMCID: PMC3999668 DOI: 10.4103/0970-2113.129815] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Burning of biomass is widely used by the rural poor for energy generation. Long term exposure to biomass smoke is believed to affect lung function and cause respiratory symptoms. MATERIALS AND METHODS Women with long term occupational exposure to burning firewood were recruited from a rural fishing community in Nigeria. A questionnaire was used to obtain information on symptoms of chronic bronchitis and spirometery was performed to measure lung function. Data obtained from the subjects was compared with that from healthy controls. RESULTS Six hundred and eighty six women were recruited for this study made up of 342 subjects and 346 controls. Sixty eight (19.9%) of the subjects had chronic bronchitis compared with eight (2.3%) of the controls (χ(2) = 54.0, P < 0.001). The subjects had lower values for the lung function as well as the percentage predicted values (P < 0.05). Fish smoking and chronic bronchitis were significantly associated with predicted lung volumes. CONCLUSION Chronic exposure to biomass smoke is associated with chronic bronchitis and reduced lung functions in women engaged in fish smoking.
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Affiliation(s)
- Victor Aniedi Umoh
- Department of Internal Medicine, University of Uyo, Uyo, Akwa Ibom State, Nigeria
| | - Etete Peters
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
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Accinelli RA, Llanos O, López LM, Pino MI, Bravo YA, Salinas V, Lazo M, Noda JR, Sánchez-Sierra M, Zárate L, da Silva J, Gianella F, Kheirandish-Gozal L, Gozal D. Adherence to reduced-polluting biomass fuel stoves improves respiratory and sleep symptoms in children. BMC Pediatr 2014; 14:12. [PMID: 24433576 PMCID: PMC3898254 DOI: 10.1186/1471-2431-14-12] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 01/14/2014] [Indexed: 11/17/2022] Open
Abstract
Background Symptoms of sleep apnea are markedly increased in children exposed to smoke from biomass fuels and are reduced by kitchen stoves that improve indoor biomass pollution. However, the impact of adherence to the use of improved stoves has not been critically examined. Methods Sleep-related symptom questionnaires were obtained from children <15 years of age in 56 families residing in the communities of Lliupapuquio, Andahuaylas province in Peru before and 2 years after installation of less-polluting Inkawasi cooking stoves. Results 82 children with lifetime exposures to indoor fuel pollution were included. When compared to those alternating between both types of stoves or those using traditional stoves only, those children who exclusively used Inkawasi cooking stoves showed significant improvements in sleep and respiratory related symptoms, but some minor albeit significant improvements occurred when both stoves were concomitantly used. Conclusions Improvements in respiratory and sleep-related symptoms associated with elevated indoor biomass pollution occur only following implementation and exclusive utilization of improved kitchen stoves.
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Affiliation(s)
- Roberto A Accinelli
- Laboratorio de Respiración del Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Perú.
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Stocks J, Hislop A, Sonnappa S. Early lung development: lifelong effect on respiratory health and disease. THE LANCET RESPIRATORY MEDICINE 2013; 1:728-42. [PMID: 24429276 DOI: 10.1016/s2213-2600(13)70118-8] [Citation(s) in RCA: 224] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Interest in the contribution of changes in lung development during early life to subsequent respiratory morbidity is increasing. Most evidence of an association between adverse intrauterine factors and structural effects on the developing lung is from animal studies. Such evidence has been augmented by epidemiological studies showing associations between insults to the developing lung during prenatal and early postnatal life and adult respiratory morbidity or reduced lung function, and by physiological studies that have elucidated mechanisms underlying these associations. The true effect of early insults on subsequent respiratory morbidity can be understood only if the many prenatal and postnatal factors that can affect lung development are taken into account. Adverse factors affecting lung development during fetal life and early childhood reduce the attainment of maximum lung function and accelerate lung function decline in adulthood, initiating or worsening morbidity in susceptible individuals. In this Review, we focus on factors that adversely affect lung development in utero and during the first 5 years after birth, thereby predisposing individuals to reduced lung function and increased respiratory morbidity throughout life. We focus particularly on asthma and COPD.
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Affiliation(s)
- Janet Stocks
- University College London, Institute of Child Health, London, UK.
| | - Alison Hislop
- University College London, Institute of Child Health, London, UK
| | - Samatha Sonnappa
- University College London, Institute of Child Health, London, UK
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Gupta D, Agarwal R, Aggarwal AN, Maturu VN, Dhooria S, Prasad KT, Sehgal IS, Yenge LB, Jindal A, Singh N, Ghoshal AG, Khilnani GC, Samaria JK, Gaur SN, Behera D. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations. Lung India 2013; 30:228-67. [PMID: 24049265 PMCID: PMC3775210 DOI: 10.4103/0970-2113.116248] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.
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Affiliation(s)
- Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V. N. Maturu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K. T. Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S. Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakshmikant B. Yenge
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A. G. Ghoshal
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - G. C. Khilnani
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - J. K. Samaria
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - S. N. Gaur
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - D. Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Oluwole O, Arinola GO, Ana GR, Wiskel T, Huo D, Olopade OI, Olopade CO. Relationship between household air pollution from biomass smoke exposure, and pulmonary dysfunction, oxidant-antioxidant imbalance and systemic inflammation in rural women and children in Nigeria. Glob J Health Sci 2013; 5:28-38. [PMID: 23777718 PMCID: PMC4776815 DOI: 10.5539/gjhs.v5n4p28] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/11/2013] [Accepted: 03/07/2013] [Indexed: 12/18/2022] Open
Abstract
Background: Exposure to particulate matter from burning biomass fuels is believed to affect oxidant-antioxidant balance and to induce oxidative stress. Methods: Fifty-nine mother-child pairs from 59 households that used firewood exclusively for cooking in three rural communities in southwest Nigeria underwent blood test for albumin, pre-albumin, retinol-binding protein (RBP), superoxide dismutase (SOD), vitamins C, vitamin E, malondialdehyde (MDA) and C-reactive protein (CRP). Spirometry was performed and indoor levels of PM2.5 were determined. Results: Mean age (± SD; years) of mothers and children was 43.0±11.7 and 13.6±3.2, respectively. The median indoor PM2.5 level was 1575.1 µg/m3 (IQR 943.6–2847.0, p<0.001), which is substantially higher than the World Health Organization (WHO) standard of 25 µg/m3. The mean levels of pre-albumin (0.21±0.14 g/dL) and RBP (0.03±0.03 g/dL) in women were significantly lower than their respective normal ranges (1-3 g/dL and 0.2-0.6 g/dL, respectively, p<0.05). Similarly, the mean levels of pre-albumin (0.19±0.13 g/dL) and RBP (0.01±0.01 g/dL) in children were significantly lower than the respective normal ranges (1-3 g/dL and 0.2-0.6 g/dL, respectively, p<0.05). Mean serum concentrations of MDA in children (5.44±1.88 µmol/L) was positively correlated to serum concentrations of CRP (r=0.3, p=0.04) and negatively correlated to lung function (FEV1/FVC) in both mothers and children (both r=-0.3, p<0.05). Also, regression analysis indicates that CRP and SOD are associated with lung function impairment in mothers (-2.55±1.08, p<0.05) and children (-5.96±3.05, p=0.05) respectively. Conclusion: Exposure to HAP from biomass fuel is associated with pulmonary dysfunction, reduced antioxidant defense and inflammation of the airways. Further studies are needed to better define causal relationships and the mechanisms involved.
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Paulin LM, Williams D, Oberweiser C, Diette GB, Breysse PN, McCormack MM, Matsui EC, Peng R, Metts TA, Hansel NN. Indoor Air Quality in Central Appalachia Homes Impacted by Wood and Coal Use. ACTA ACUST UNITED AC 2013; 4:67-71. [PMID: 27738549 DOI: 10.4236/jep.2013.41007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Though the high prevalence of biomass fuel use in the developing world is widely known, the use of burning biomass for cooking and heating in the developed world is under-recognized. Combustion materials including coal and wood are also used for heating in some areas of the United States. We conducted a pilot study to assess the feasibility of conducting indoor environmental monitoring in rural Appalachia. We sought to explore the type of biomass being used for home heating and its impact upon indoor air quality in non-heating and heating seasons. Residential indoor air monitoring for particulate matter (PM) and nitrogen dioxide (NO2) was conducted in Lee County, Virginia. Homes had evidence of poor indoor air quality with high concentrations of indoor PM and a large burden of cigarette smoking. Further characterization of indoor combustion material use in this region to determine the health impacts associated with such exposures is warranted.
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Affiliation(s)
- Laura M Paulin
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - D'Ann Williams
- Division of Environmental Health Engineering, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Gregory B Diette
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Patrick N Breysse
- Division of Environmental Health Engineering, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Meredith M McCormack
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Elizabeth C Matsui
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Tricia A Metts
- Department of Environmental Health, East Tennessee State University College of Public Health, Johnson City, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
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Abstract
Almost 3 billion people worldwide burn solid fuels indoors. Despite the large population at risk worldwide, the effect of exposure to indoor solid fuel smoke has not been adequately studied. Indoor air pollution from solid fuel use is strongly associated with chronic obstructive pulmonary disease, acute respiratory tract infections, and lung cancer, and weakly associated with asthma, tuberculosis, and interstitial lung disease. Tobacco use further potentiates the development of respiratory disease among subjects exposed to solid fuel smoke. There is a need to perform additional interventional studies in this field.
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Affiliation(s)
- Akshay Sood
- Department of Medicine, School of Medicine, Health Sciences Center, University of New Mexico, 1 University of New Mexico, MSC 10 5550, Albuquerque, NM 87131, USA.
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